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CMS RVU26D · Effective 2026-10-01

43611 Stomach lesion excision Medicare reimbursement rates in Indiana

Report this code for extensive transabdominal removal of a stomach lesion through a gastrotomy, when the operation is more than a limited excision or biopsy. Compare 43611 office and facility rates across CMS payment localities in Indiana.

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

What does Medicare pay for 43611 in Indiana?

Indiana has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.

Office / nonfacility

No supported rate

Facility setting

$1040.50

1 of 1 localities have a supported rate.

Payment area: Indiana

One mapped payment locality.

These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.

Find 43611 in your payment locality →

Gastric surgery

About 43611: Extensive gastric lesion excision

Report this code for extensive transabdominal removal of a stomach lesion through a gastrotomy, when the operation is more than a limited excision or biopsy.

A surgeon uses a transabdominal approach to open the stomach and remove an extensive lesion, then closes the stomach. The operation is performed in a surgical setting, commonly by a general or gastrointestinal surgeon. It differs from taking a tissue sample for diagnosis and from removing a portion or all of the stomach as a gastrectomy.

Choose this code when the operative report supports extensive local lesion removal; document the lesion, the extent of excision, the gastrotomy, and the work performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

CMS billing rules for 43611

Global period
Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
Multiple procedures
Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
Bilateral procedures
Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
Assistant at surgery
Assistant at surgery may be paid.
Co-surgeons
Co-surgeons paid only with supporting documentation.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU19.87 · 58%
  • Practice expense (office) RVU9.57 · 28%
  • Malpractice RVU4.96 · 14%

542

Medicare services in 2024 · #3484 by national volume

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

43611 compared with similar codes

Office rates for Indiana, from the same CMS release.

43610

Gastric lesion excision

Without partial gastrectomy

No office rate

Both involve transabdominal lesion excision through a gastrotomy. The distinction is limited versus extensive excision, supported by the operative report.

43605

Stomach biopsy

Open abdominal approach

No office rate

43605 represents stomach biopsy for tissue diagnosis. Use 43611 when the surgeon performs extensive removal of the lesion rather than sampling it.

43631

Partial gastrectomy

Distal, gastroduodenostomy

No office rate

43631 describes distal partial gastrectomy, which removes a portion of the stomach. 43611 is for extensive local lesion excision, not a partial gastrectomy.

Compare 43611 by payment locality

Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.

1 of 1 payment localities

Office and facility base rates · shared scale starting at $0

  • Indiana →

    Office / nonfacility

    Unavailable

    Facility

    $1040.50

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How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 43611 in Indiana.

PPRRVU2026_Oct_nonQPP.csv

5,264

Code
43611
Physician work
19.87
Practice expense
9.57
Malpractice
4.96

GPCI2026.csv

52

Locality
Indiana
Physician work
1.000
Practice expense
0.927
Malpractice
0.486
Facility calculation for 43611 in Indiana
ComponentRVULocality factorAdjusted
Physician work19.87× 1.00019.8700
Practice expense9.57× 0.9278.8714
Malpractice4.96× 0.4862.4106
Total RVUs31.1520
Conversion factor× 33.4009

Facility rate, Indiana$1040.50

Explore RVUs, geographic factors and the full formula

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work19.871
Practice expense9.570.927
Malpractice4.960.486

(19.87 × 1 + 9.57 × 0.927 + 4.96 × 0.486) × $33.4009 = $1040.50

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

43611 billing questions

How does this differ from 43610?

Both describe transabdominal excision of a stomach lesion through a gastrotomy. Choose 43611 for an extensive excision and 43610 for a limited one, based on the operative work documented.

When should a stomach biopsy code be used instead?

Use 43605 when the surgeon obtains tissue for diagnosis rather than performing extensive lesion removal. A biopsy does not represent the excision described by 43611.

Does the 90-day global include postoperative care?

Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can modifier 50 be appended for lesions on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.

How are multiple procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 43611PPRRVU2026_Oct_nonQPP.csv, line 5,264 (RVU26D)
Geographic factors for IndianaGPCI2026.csv, line 52 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet